- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT03133910
Pharmacokinetics and Pharmacodynamics of Ceftazidime in Pediatric ICU Patients
25. april 2017 oppdatert av: Ann & Robert H Lurie Children's Hospital of Chicago
Mortality benefit has been proven with early antibiotic administration in sepsis.
Antimicrobial therapy should be based on early achievement of effective drug concentrations by optimizing the pharmacokinetic/pharmacodynamics of individual drugs.
Optimal dosing in the critically ill patient can be challenging with the rapidly changing physiology of sepsis during the first days of hospitalization with capillary leak, fluid overload, changes in cardiac output, and alterations renal clearance.
Ceftazidime is the preferred beta-lactam for empiric treatment of sepsis at Lurie Children's Hospital because of its anti-pseudomonal and anti-enteric bacilli coverage, however, the majority of pharmacokinetic data currently published in pediatrics does not include Intensive Care Unit (ICU) patients.
Adult pharmacokinetic/pharmacodynamics data suggest that critically ill adults with high level of illness severity may benefit from continuous or extended infusion beta lactam therapy to optimize the therapeutic concentration particularly for pathogens that are relatively resistant to beta-lactams.
Understanding the changing pharmacokinetic/pharmacodynamics of ceftazidime with the progression of illness in the ICU may help determine if current dosing regimens are adequate to maintain appropriate drug concentrations to optimize antimicrobial treatment.
Studieoversikt
Status
Ukjent
Forhold
Detaljert beskrivelse
Severe sepsis continues to be a leading cause of admission and death in the pediatric critical care population.
Mortality benefit has been proven with early antibiotic administration.
Optimal antimicrobial therapy should be based on early achievement of effective drug concentrations by optimizing the pharmacokinetic/pharmacodynamics of individual drugs.
Ceftazidime is the preferred beta-lactam for empiric treatment of sepsis at Lurie Children's Hospital because of its anti-pseudomonal and anti-enteric bacilli coverage, however, the majority of pharmacokinetic data currently published in pediatrics does not include ICU patients.
For beta-lactams like ceftazidime, the time that free (nonprotein bound) drug concentration remains above the minimum inhibitory concentration (MIC) of the bacteria (t>MIC) best defines the bacteriostatic and bactericidal activity.
Based on previous animal studies and subsequent clinical studies, beta-lactams require about 50% t>MIC.
Adult pharmacokinetic/pharmacodynamics data suggest that critically ill adults with high level of illness severity may benefit from continuous or extended infusion beta lactam therapy to optimize time above MIC particularly for pathogens that are relatively resistant to beta-lactams.
Positive outcome results using extended infusion have been found with respect to mortality benefit, clinical cure, reduced length of stay, and increased ventilator free days.
It is likely that because children experience changes in physiology with critical illness likely leading to alteration in antibiotic clearance, additional data are needed to determine if our current dosing strategies are achieving optimal antimicrobial exposure.
Understanding the changing pharmacokinetic/pharmacodynamics of ceftazidime with the progression of illness in the ICU may help determine if current dosing regimens are adequate to maintain appropriate t>MIC.
In this study all patients between the ages of 2 months and 18 years admitted to the Pediatric Intensive Care Unit/ Cardiac Intensive Care Unit (PICU/CICU) who will receive ceftazidime for empiric or definitive antimicrobial therapy with an expected duration of greater than or equal to 48 hours who meet inclusion criteria will be enrolled in this prospective, non-interventional, pharmacokinetic study.
Sampling of serum to determine concentrations will occur around ceftazidime doses during the first 48 hours after admission or onset of hospital associated illness, with additional sampling up to 7 days if antibiotic use continues.
Using a traditional FDA-approved dosing regimen (50 mg q 8hr with maximum dosing of 6g/d), samples will be drawn following the 2nd or 3rd dose of Ceftazidime received by the patient at times: 0 min (predose), 30 min, 1 hour, and 4 hours following dose.
During the second 24 hours of therapy, one sample will be drawn between hours 2 and 4 post dose and if therapy continues additional samples will be drawn daily between hours 2 and 4 post dose up to 7 days.
Additional information will be collected to better assess volumes of distribution, drug clearance, kidney function, and cardiac output to determine patient covariates that may help delineate which patient populations associated with altered ceftazidime exposure.
Population pharmacokinetic modeling will be performed and various regimens will be simulated to identify optimal dosing.
Studietype
Observasjonsmessig
Registrering (Forventet)
20
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
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Illinois
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Chicago, Illinois, Forente stater, 60611
- Ann & Robert H Lurie Childjren's Hospital of Chicago
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Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
2 måneder til 18 år (Barn, Voksen)
Tar imot friske frivillige
Nei
Kjønn som er kvalifisert for studier
Alle
Prøvetakingsmetode
Ikke-sannsynlighetsprøve
Studiepopulasjon
Patients between the ages of 2 months and 18 years admitted to the PICU/CICU who will receive ceftazidime for empiric or definitive antimicrobial therapy with an expected duration of greater than or equal to 48 hours.
Beskrivelse
Inclusion Criteria:
- Admitted to pediatric or cardiac intensive care unit
- Between the ages of 2 month to 18 years
- Receiving ceftazidime for an anticipated course of greater than or equal to 48 hours
- Central venous or arterial access for blood sampling
Exclusion Criteria:
- Less than 2 months or greater than 18 years
- Anticipated need for renal replacement therapy or ECMO
- History of chronic kidney disease greater than stage 1
- Inadequate access for blood draws
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Duration of time that antibiotic concentration is above the minimum inhibitory concentration (T>MIC) of common gram negative bacteria
Tidsramme: Blood sample collection beings within 24 to 32 hours of antibiotics administration. Day 1 collections times are zero (predose); 30 minute post dose; 1 hour post dose; 4 hour post dose. Day 2 through 7 collections times occur 2 to 4 hour post dose.
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Number of patients with altered ceftazidime concentrations due to critical illness as measured by less that 50% T>MIC.
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Blood sample collection beings within 24 to 32 hours of antibiotics administration. Day 1 collections times are zero (predose); 30 minute post dose; 1 hour post dose; 4 hour post dose. Day 2 through 7 collections times occur 2 to 4 hour post dose.
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Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Erin Bradley, MD, Ann & Robert H Lurie Children's Hospital of Chicago
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Faktiske)
9. mars 2017
Primær fullføring (Forventet)
1. januar 2018
Studiet fullført (Forventet)
1. januar 2019
Datoer for studieregistrering
Først innsendt
9. mars 2017
Først innsendt som oppfylte QC-kriteriene
25. april 2017
Først lagt ut (Faktiske)
28. april 2017
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
28. april 2017
Siste oppdatering sendt inn som oppfylte QC-kriteriene
25. april 2017
Sist bekreftet
1. april 2017
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Andre studie-ID-numre
- 2016-679
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
NEI
Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .
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